By Beth E. Michel, MLD, CPHRM; MedPro

The concept of performance improvement is discussed frequently among members of the healthcare community. We generally understand that to improve patient outcomes, we must improve performance, or the delivery of care.
Yet, when juggling implementation of new evidence-based practices, adoption of new technologies, and healthcare reform, it is easy for “performance improvement” to become just a phrase rather than a daily conscious focus for healthcare providers.

This article brings the issue of performance improvement back into focus by examining ways in which you can use an electronic health record (EHR) system to support positive change in your practice.

Using an EHR System To Drive Performance Improvement

A well-defined performance improvement process involves identifying opportunities for improvement, designing and conducting an audit, implementing a corrective action plan, and evaluating for continued improvement.
Because EHR systems collect a wealth of data, they can be a valuable tool in the performance improvement process. However, the challenge is understanding how to aggregate and analyze the data, evaluate the results, and then develop strategies and initiatives to improve the delivery of care and generate better patient outcomes.
The following sections of this article discuss some specific ways in which your practice can meet this challenge and incorporate your EHR system into quality initiatives.

High-Risk Situations

Identifying situations that create high risk for your practice should be the starting point when considering how EHR data can help you develop performance improvement goals. A few common, high-risk situations are discussed below.

Test Result Tracking

Failure to address all test results is a frequent underlying cause of the top allegation in medical malpractice claims—failure to diagnose. Having a well-articulated procedure for tracking patients’ lab, radiology, and other test results can help mitigate this risk.
Many EHR systems can assist in automating test tracking, improving both timeliness and completeness of the function. For example, evaluate your EHR system to make sure you can generate data showing (a) all tests that have been ordered, (b) all test results that have been received and reviewed by the ordering healthcare provider, and (c) all test results that have been communicated to patients.

You may also find it helpful to have your system generate a daily task list that flags certain situations that could lead to risk exposure. Circumstances that should be flagged include (a) tests ordered, but no results received, (b) test results received, but not viewed by the healthcare provider, and (c) test results viewed by the healthcare provider, but not communicated to the patient.
Routinely running reports to identify overlooked test results is critical, even if test results are included on your daily task list. These reports can assist in your practice’s efforts to ensure no test results go missing or unnoticed.

Drug Interaction and Allergy Alerts

Many EHRs are capable of alerting providers to potential dangerous drug interactions and allergies. These alerts can sometimes be overwhelming; however, when implemented as part of a well-designed system, they can protect patients and help prevent prescribing errors.
Work with your EHR vendor to (a) ensure your practice is realizing the full potential of the system’s alert functions, and (b) tailor the alerts to meet the specific needs of your practice.
Also, it is imperative to realize that drug and allergy alerts work only if current data are available for the system to analyze. Thus, it’s important to make sure the providers in your practice are reviewing patients’ allergies at each office visit and updating the system during the patient encounter.

Cancelled Appointments and “No Shows”

For both patient safety and liability reasons, healthcare practices need thorough processes for identifying, addressing, documenting, and following up on cancelled and missed appointments—especially in regard to noncompliant and/or difficult patients.

Although patients share in the responsibility for their care and ultimately need to make the effort to keep appointments, a well-documented follow-up call or letter from the practice can (a) remind and encourage the patient to make a visit, which may ultimately affect the patient’s outcome, and (b) establish the practice’s commitment to ensuring the patient receives necessary care.

Your practice can use its EHR system to document cancelled and missed appointments and better manage these patients. For example, your practice might use its system to generate a daily report showing all appointments for the previous day that were cancelled or missed. This information will help pinpoint and streamline follow-up communication and tracking.

Further, with thorough data input, the system can generate reports showing whether follow-up has occurred, how quickly it occurred, and the outcome of the follow-up. This information provides evidence of the practice’s efforts on behalf of the patient.

Helpful Tip
Make sure providers and staff in your practice are consistently using the EHR system to track test results. The automated functions built into the system should not be circumvented. For example, do not use a paper tickler system as a workaround.


The situations described previously—test tracking, drug interactions and allergies, and appointment cancellations and “no shows”—are examples of common risk areas you may want to consider including in your practice’s performance improvement efforts.

Once you have selected a specific area for improvement, you will need to design and conduct an audit. An audit is a way of measuring outcomes (performance metrics) against expectations that have been defined in office policies, procedures, standards, or guidelines.

When selecting measures to include in your audit, make sure that your office staff has a working knowledge of the data elements and definitions associated with your EHR. Providing the team with a list of these elements and definitions when discussing possible measures is helpful.

Information regarding evidence-based standards specific to the patient population you serve and your practice’s involvement in mandatory and/or voluntary quality data reporting initiatives also is relevant to the audit that you design. At minimum, the audit process that you implement should include the following for each measure selected:

  • Definition Create a clear statement of the metric to be measured. For example—“Communication of all tests results to patients.”
  • Goal Develop a broad statement describing the intended result. For example—“This office will communicate the results of all tests to patients within an appropriate timeframe based on the results and the patient’s condition.”
  • Target Establish a target outcome so the practice can determine the significance of the results. Consider best practices, benchmarking data, and evidence-based treatment when setting targets. For example—“Ninety percent of all test results will be communicated to patients within an appropriate timeframe set by office policy, and 100 percent of all critical test results will be communicated to patients within a timeframe established by applicable professional guidelines. Communication of results will be documented in each patient’s chart with a revised treatment plan, if appropriate.”
  • Methodology Describe the method you will use to obtain data. For example—“Run EHR system reports to identify all test results that have been received but are still pending follow-up with patients.”
  • Frequency Explain how often you will measure the metric. For metrics that have an immediate impact on patient safety, consider more frequent measurements, such as daily or weekly.
  • Corrective actions Describe what you will do to improve the results if your target is not met. Will you implement a new workflow process, reallocate resources, or take another action?
  • Monitoring Describe how you will monitor any changes over time. Will you continue to measure the metric for a year or longer? How often will you perform spot checks to ensure continued improvement or consistent results?

MedPro Group’s guideline “Using an Electronic Health Record System as a Risk-Reduction Tool” contains additional details and guidance about the audit process. You can access the document here.


Delivery of healthcare in a safe and efficient manner is the goal of all practitioners. Being mindful of opportunities for improvement and willing to invest time and energy to address those opportunities can be a challenge.

However, a well-designed EHR system is an excellent tool for risk mitigation, quality checking, and long-term performance improvement monitoring. The activities of aggregating and analyzing data—as well as taking action based on the findings—are critical to delivering quality patient care, preventing errors, and minimizing risk within your healthcare practice.
In the long run, efforts to identify and address gaps in performance and develop corrective plans can help improve patient outcomes, increase patient satisfaction, and possibly reduce your liability exposure.

This article was produced by the Patient Safety & Risk Solutions Team at Medical Protective, a TDA Perks Program partner and a national leader in healthcare malpractice insurance coverage and risk solutions. For additional information, please visit the Medical Protective website at

The information provided in this article should not be construed as medical or legal advice. Because the facts applicable to your situation may vary, or the regulations applicable in your jurisdiction may be different, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal statutes, contract interpretation, or legal questions. © 2016 Medical Protective. ® All rights reserved.